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Tilting at Windmills

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April 26, 2009
By: Hilzoy

Swine Flu

From the Washington Post:

"The World Health Organization rushed to convene an emergency meeting Saturday to develop a response to the "pandemic potential" of a new swine flu virus that has sparked a deadly outbreak in Mexico and spread to disparate parts of the United States.

Health officials reported that at least eight students at a private high school in New York City had "probable" swine flu. They also confirmed three new cases -- two in Kansas and one in California -- bringing the total number of confirmed U.S. cases to 11. The president of Mexico, where the outbreak has killed as many as 81 people, issued an order granting his government broad powers to isolate patients and question travelers. (...)

The virus, for which there is no vaccine for humans, has nearly brought Mexico City to a halt. Normally congested downtown streets in this city of 20 million were almost empty Saturday, and of the few people who ventured outside, many said they did so only out of necessity. Soldiers posted at subway stations handed out face masks to passersby from the back of armored vehicles. Some pedestrians covered their mouths and noses with scarves and rags.

"We can't escape the air," said Antonio Gonzáles, 56, who wore a surgical mask outside a public hospital. "If it was something in the food, we'd have a chance."

The Mexican government reported more than 1,300 suspected cases of the virus, which mixes animal and human strains of flu. Bars and nightclubs, schools, gallery openings and sporting events were cancelled until further notice. Authorities advised people to wash their hands regularly and avoid the customary greeting of kissing on the cheek. The government issued a decree giving the Health Ministry power to enter people's homes, close public events, isolate patients, and inspect travelers and their baggage.

The Associated Press reported that 24 new cases of the flu emerged Saturday in Mexico."

Thus far, the Mexican version seems to be much more virulent than the US version, despite the fact that "partial comparisons of the genetic sequences of the Mexican and American cases shows them to be essentially the same". There could be any number of explanations for this: "some difference in the information (looking at severely ill versus routine surveillance of outpatients), some difference in the virus (while the viruses are said to be "genetically identical" this is true only in the parts that have so far been compared) or some co-factor (e.g., co-infection with another pathogen)."

However, it seems likely that there has been human-to-human transmission, which is worrisome. Moreover, the casualties in Mexico seem to have been disproportionately healthy young adults. On NPR today, Laurie Garrett gave two possible explanations for this: it might be that children and the elderly got the regular flu vaccine, and that it confers some protection to this new strain of influenza, which would be good; or it might be the dreaded cytokine storm: basically, a lethal overreaction by the immune system. This is thought to be the reason why young adults were disproportionately represented among the casualties of the pandemic of 1918: since they have stronger immune systems, the overreaction was more likely to be fatal.

If we're lucky, this will continue to be relatively mild in this country, and the steps Mexico is taking will do the trick. Just in case, though, now might be a good time to download this flu manual (pdf; h/t DemFromCT at dKos.) Unnecessary preparation beats being caught unprepared by a flu pandemic.

Good blogs on this topic: Effect Measure, H5N1, Aetiology, DemFromCT at dKos, ScienceInsider.

Hilzoy 12:31 AM Permalink | Trackbacks | Comments (36)

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It is good news that the suspected cases in NY and elsewhere appear milder than in Mexico. Though further testing is needed to determine if it's the Type A version of Swine Flu, or completely new like the strain in Mexico.

Posted by: Mr. Stuck on April 26, 2009 at 12:46 AM | PERMALINK

In related news, Rick "Jefferson Davis" Perry just asked the federal government for "37,430 courses of antiviral medications from the Strategic National Stockpile to Texas to prevent the spread of swine flu."

Wonder if he thought about things like this before shooting his mouth off last week.

Posted by: Seitz on April 26, 2009 at 12:47 AM | PERMALINK

One thing not mentioned in the post: it is believed that older people had been exposed to an earlier variant of the Spanish flu as young people during a milder epidemic 20-years before. I suspect, with all the professional credibility of George Will on Global Warming, that we might be seeing the impact of earlier immunizations. Some of us had the Swine flu vaccine back when Carter was president, and we have except for Bushes bungling a few years ago, been subjected to numerous courses of flu vaccinations. My hope is that Americans are uniquely prepared.

Survivors of this outbreak are hugely important in the development of vaccines; may not be enough time. Then again--we are at the end of flu season largely and this may help us dodge a bullet.

Posted by: Sparko on April 26, 2009 at 12:54 AM | PERMALINK

I'm working from decade-old memories of The Hot Zone here, but I seem to recall that species-jumping viruses tend to either get more lethal as they move from human host to human host, or (more commonly, fortunately), the lethality attenuates. Maybe that's what is happening with the US cases?

Posted by: tavella on April 26, 2009 at 12:54 AM | PERMALINK

"Prepare your records in case you die"

that's a piece of the advice in the influenza manual provided at the link.

it recommends you store one to three months worth of nonperishable food: "In the event of a pandemic you should be prepared to live without normal access to grocery stores and pharmacies."

if i was the least bit prone to panicking, this would certainly do it for me.

Posted by: karen marie on April 26, 2009 at 1:16 AM | PERMALINK

Karen Marie -- agreed that seeing a "prepare your records before die" isn't a happy feeling, but it's a good idea, pandemic or not.

Storing 1-3 months of non-perishable food before the general population decides it's a good idea is better than waiting for a crazed rush, and unlike stockpiling weapons, it might actually help the community at large in the event of a pandemic.

In the event, it'll be just like the winter of 2001 where every panicked wealthy person in the U.S. scored Cipro, depleting the stocks in the event of a serious outbreak.

Posted by: Buck on April 26, 2009 at 2:09 AM | PERMALINK

Wash your hands. Avoid touching your eyes. Sneeze into the crook of your arm.

If you are sick, don't go to work. Avoid places with large numbers of people. Remember to wash your hands once more.

Put a container of hand sanitizer in your office and in your car, so when you can't wash your hands you can use it. If you take public transit, be very aware that every place you sit, someone with a virus may have sat before you. If you hold onto a door or a pole, be conscious NOT to touch your face or your eyes until you, you guessed it, wash your hands again.

We have much better support for people with massive infection than in 1918. We know better how to support respiratory failure. And we know better how to prevent transmission.

Posted by: IT on April 26, 2009 at 2:15 AM | PERMALINK

it's a shame this is happening in mexico, both because they're suffering and dying and because it will give the anti-immigration nuts here something scary to shriek about.

thanks for the sensible words above, folks. i'm just cranky because i hate canned food. i very much appreciate the availability of the manual, read it and recommend others to read it.

Posted by: karen marie on April 26, 2009 at 2:23 AM | PERMALINK

We have much better support for people with massive infection than in 1918. We know better how to support respiratory failure. And we know better how to prevent transmission.

Also, there is apparently some evidence that virus-inhibiting drugs like Tamiflu are effective with this strain of swine flu if (as with all flus) they're administered early. This may be the year that it's an especially good idea to call your doctor as soon as you start feeling flu-ish.

Posted by: Mnemosyne on April 26, 2009 at 2:33 AM | PERMALINK

this is definitely scary stuff, sounds a lot more serious than the peanut butter salmonella scares at the very least

Posted by: Nomad on April 26, 2009 at 2:34 AM | PERMALINK

This is where common sense pays off. If you work in the travel industry, then make sure you have hand sanitizer available at all times. If your city reports flu cases are up, then maybe the availability of a face mask would be in order, depending on the number of cases in your area. If you do not feel well, for god's sake -- DON'T go to work.

The CDC is all over this. There will be more information coming out soon. I don't really know if we need to assume that we have to have a couple of months worth of canned food available, BUT we do live in interesting economic times. It wouldn't hurt to think ahead, and make sure there are some provisions in the freezer and in the pantry.

Posted by: jcricket on April 26, 2009 at 2:50 AM | PERMALINK

Yes, check your personal supplies. You should have them no matter what. A Pandemic is no different from an earthquake or ice storm or any other travel limiting catastrophe and we should always Be Prepared.
Mean time, if you do get sick, Call Your Doctor Immediately. Get one of the anti-virus drugs into you. If you don't have insurance or can't afford the fancy drugs, do stay home and Take Care of Yourself. People who survive these things are people who avoid secondary infections, and you do that by resting and drinking lots of fluids.
Take care out there! And Wash Your Hands!
PS If you boss won't let you take the time off work, be sure to sneeze on the boss. Serves the boss right!

Posted by: Lisa Harrigan on April 26, 2009 at 2:50 AM | PERMALINK

"...Thus far, the Mexican version seems to be much more virulent than the US version, despite the fact that "partial comparisons of the genetic sequences of the Mexican and American cases shows them to be essentially the same"..."

I'm wondering if there are some population differences that might have something to do with differential resistance. I'm looking at my human variation and adaptation books, but so far I haven't come upon anything specific to influenza, although there is variation between populations and other types of epidemics and diseases.

Posted by: Varecia on April 26, 2009 at 2:57 AM | PERMALINK

It's now way too late to contain this outbreak. Individuals and businesses need to use the time left to get at least the fundamentals of their business and home preparedness completed. The pandemic preparedness section of Bird Flu Manual Online can help.

Posted by: Nigel Thomas on April 26, 2009 at 3:00 AM | PERMALINK

You may also want to read this:

Posted by: Roy Schwartz on April 26, 2009 at 4:41 AM | PERMALINK

Whoa whoa whoa, people. There's far too much reasoned dialogue and helpful information in this thread. And not nearly enough useless panicking or conspiracy theorizing. How am I supposed to keep myself entertained in an environment like this? Eh?! At this rate I'll have to visit one of those right winger sites to get my jollies. Anyone know the url for redstate.com?

Feh. Well, anyhow, carry on. And good job being so damned sensible, since you all seem to be into that sorta thing.

Posted by: Kellerian II on April 26, 2009 at 7:35 AM | PERMALINK

Finally, I find a benefit to being older and a bit unhealthy! (Sorry, couldn't resist a little black humor).

Forget vaccinations; clearly this calls for more doughnuts.

Btw, I wonder if Novavax (stock symbol: NVAX) has a potential vaccine solution if a pandemic occurs.

Posted by: Kevin Hayden on April 26, 2009 at 7:47 AM | PERMALINK

I waited for a plane in the Dallas airport on Friday night, and as one is forced to do in public places with big screen TVs, overheard what was being broadcast. There, Lou Dobbs was reporting on this story. Though I made a note to follow-up, I didn't pay much attention; Given the source--commercial TV, Lou Dobbs--I just assumed that it was this week's media frenzy du jour.

It is an interesting case, for me, of whom one trusts for information. If anyone on Fox is worried, I start by assuming the opposite to be true. If CNN talking heads are worried, I make a note to follow-up in sources I trust more. If Hilzoy is worried, I'm a little more worried.

Posted by: PTate in MN on April 26, 2009 at 8:22 AM | PERMALINK

Blue Girl, please check in with your wisdom on this matter.

Posted by: berttheclock on April 26, 2009 at 8:53 AM | PERMALINK

I seem to recall that species-jumping viruses tend to either get more lethal as they move from human host to human host

I think it depends upon how it spreads. There's a theory, I think it is somewhat tested and accepted now, that says that we can shape the course of an epidemic. If the bug gets to spread easily -- with no transmission penalty for killing its host -- then there's no check on it being really deadly. This is one theory why the 1918 flu was so bad -- it incubated in military hospitals, where it could spread easily. This is also why the common cold is so successful as a virus; it usually leaves you unsick enough that you can get out and around and continue spreading it (there are lethal exceptions to this rule, like AIDS, where you can transmit the bug when you don't feel sick).

By this theory, what Mexico is doing, is wonderful. Make that flu bug work hard to spread, and the only instances that will get a chance to spread, will be those that don't make people that sick. To the extent that this theory is true (and works in this case), we are very much in their debt. Even if they don't fully contain the bug, they might shape it into a less-lethal, less-expensive flu.

And Rick Perry should also be exhorting all Texas citizens to wash their hands often, to NOT go to work/school if they feel sick, and so on.

Posted by: dr2chase on April 26, 2009 at 9:38 AM | PERMALINK

It's got to be a pretty ill wind that doesn't blow some good---how long do you think before Glenn Beck reads the wire and does his Louis del Grande imitation on live TV?

Posted by: Steve Paradis on April 26, 2009 at 10:17 AM | PERMALINK

"i hate canned food" says karen marie, and it's not an unreasonable attitude. You might consider stocking up on more frozen stuff - vegetables, fruits, etc. The flavor is usually much closer to fresh. Plant lettuce - if you don't have a yard or garden, a big pot or window box will do. You can make some really excellent soups and stews based on legumes, which keep for months on the shelf, dry.

Many women today consider cooking to be a sign of housewifery and bondage, and just won't do it. If so, see if you can enlist a male significant other to play chef.

Posted by: Zandru on April 26, 2009 at 11:12 AM | PERMALINK

If the US version is actually less virulent and genetically indistinguishable then we should be promoting it's transmission to protect the population from the Mexican variety.

Of course, both may be present in the US already...

Posted by: Tentakles on April 26, 2009 at 11:58 AM | PERMALINK

Tell me What Liberal idiot made the statements about Bush. Come on the guy already has taken blame for the 9/11, hurricanes in New Orleans, Global Warming, the list goes on and on..

Posted by: freddie warrick on April 26, 2009 at 12:18 PM | PERMALINK

Tentakles: "If the US version is actually less virulent and genetically indistinguishable then we should be promoting it's transmission to protect the population from the Mexican variety.

Of course, both may be present in the US already..."

I'm not so sure it's two different strains. I'm wondering if the difference may really be in the populations that are exposed to it. If the past is any indication, New World native populations suffered with Old World diseases and epidemics for which they had no prior exposure and thus resistance, including some of influenza, although smallpox is most often cited. It could be that there is a component or components to this flu that mesoamerican populations don't have a history of exposure to. While this flu may have made some critical jump from one form to another *in* Mexico, I'm also wondering if it started from something originating overseas that was brought to Mexico where it then morphed something slightly new. I could be way off on this, but it's not inconsistent with what I studied about human variation and adaptation in anthropology.

Posted by: Varecia on April 26, 2009 at 12:25 PM | PERMALINK

"Less virulent" and "genetically indistinguishable" are contradictions. A virus is a set of genes with a protein coat, and the genes contain the instructions for that protein coat. If two virus strains are genetically indistinguishable, they are identical and will have identical effects. What's actually going on, I suspect, is that they are slightly different: viruses tend to mutate rapidly.

Posted by: Joe Buck on April 26, 2009 at 1:02 PM | PERMALINK

Joe Buck: "...If two virus strains are genetically indistinguishable, they are identical and will have identical effects..."

But the people who are exposed may have different population histories, so the effects may not be identical. The business man in Kansas who recently traveled to Mexico where it is believed he contracted the flu did not suffer as severe a reaction as the people who live in Mexico. Likely the same flu, but they are derived from different populations with different histories.

Posted by: Varecia on April 26, 2009 at 1:14 PM | PERMALINK

Time to get all the pharmaceutical and alternative treatments stockpiled at home, along with food, water and some good books.

Posted by: grace on April 26, 2009 at 2:27 PM | PERMALINK

The old saying: "An ounce of prevention...." is still true. Isn't the key to resistance of virus's like this in boosting your immune system? The Swiss have it right-they made the OM24 anti-oxidant that super-supports the immune system. With an ounce of that prevention you won't need to worry about any mutations. Makes sense to me--Don't Panic, Just Protect!

Posted by: Judy Dudley on April 26, 2009 at 2:48 PM | PERMALINK

And *if* the need to stock up on things arises, don't forget pet food and supplies! Make sure to have enough pet carriers on hand as well. My city's emergency response program includes facilities for animals, and if you have to transport any you'd need them.

Posted by: Varecia on April 26, 2009 at 3:26 PM | PERMALINK

Blue Girl, please check in with your wisdom on this matter.

Hi Bert. As is my wont when life and death are on the line, I am being very cautious...and calling friends who are still in the public health sector and therefore in a better position to know what the hell we are dealing with here than I to address authoritatively. At present I would merely be speculating and this is no time for speculation. I will, however, (hopefully) have a post at my place later today that pulls together some of the excellent advice given upthread; and a more virology-focused post when I have a better idea the nature of the virus. What I am trying to find out right now is the nucleotide sequence of the virus in Mexico and overlay it with the one we are dealing with in this country. My gut instinct is that they are the same virus, and the symptoms presenting are milder here due to population differences in general health, public health efforts that have brought us 'herd immunization' and other factors that fall under that umbrella.

Posted by: Blue Girl on April 26, 2009 at 5:02 PM | PERMALINK

The best defense is washing your hands frequently, and if you are out in public, wear a FDA approved respirator.

The FDA approved respirators are available to the general public directly from 3M Corporation through their on-line store. There are two styles of NIOSH N95 certified respirators at www.Shop3M.com: a flat-fold (Model 8670F) that stores easily in a purse, and a cup style (Model 8612F). Additional information, including product usage instructions, is available at www.my3MN95.com.

Posted by: Tom Gearman on April 26, 2009 at 5:16 PM | PERMALINK

PLEASE--alcohol-FREE hand sanitizers are equally if not more effective, and safer to the skin..and provide greater persistency, and can applied to cuts/abrasions and can penetrate dirty skin.
many good products available....alcohol-based gels provide NONE of those benefits..but they're good for mixing with club soda and good for destroying industrial floor wax...are you getting the point??...nice selection of products and information at www.soapyusa.com

Posted by: drstu on April 26, 2009 at 7:48 PM | PERMALINK

How can you prevent the spread of swine flu in children?

Teach them how to not get and give germs with the new Germy Wormy Germ Smart for kids teaching program. With this seriousness of this new flu, it may save their lives.


Posted by: Margaret Bakc on April 26, 2009 at 9:22 PM | PERMALINK

I guess it's up to me to provide some political commentary amongst all the public health info above:

Thank effing god that we got some adults in the WH just in time to deal with this. If GWB/Cheney were still in power, surely they would have bombed Mexico City by now.

Posted by: Disputo on April 27, 2009 at 2:40 AM | PERMALINK

My latest web comic about the whole thing: http://bit.ly/t9R4D

Posted by: Wayne on April 27, 2009 at 2:59 AM | PERMALINK



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